The cost of health care in the United States has long been rising at an alarming rate — including and especially when it comes to diabetes care. Meanwhile, the cost of many communication devices that were once shockingly expensive — such as those allowing mobile videoconferencing — has dropped drastically and continues to drop, as their features multiply and their quality improves. Naturally, researchers have been trying for years to use this positive trend in technology to find ways to reverse the negative trend in health-care costs. And so far, the results have been mixed.
Telemedicine — connecting patients with health-care professionals through videoconferencing, computer software, and other data organization and communication tools — has taken various forms throughout the years, with varying goals. A recent study, published in the journal Health Affairs, looked at data from a pilot program started by the Centers for Medicare and Medicaid Services to examine cost-saving techniques for high-cost patients with diabetes, chronic obstructive pulmonary disease, or congestive heart failure. The technology used in the program is not exactly cutting-edge anymore: According to an article on the study at InformationWeek.com, the Health Buddy is a handheld device with a color screen and four buttons that is connected to the Internet. Patients use it to answer questions about their health and behavior, and this information is sent to a computer database where a program analyzes the data and then notifies a “care manager” of any patients who are likely to need guidance or assistance. The study looked at 1,767 participants in the pilot program and compared them with an equal number of nonparticipants (both groups consisted of Medicare patients) over the same two-year period, during and after the pilot program. Using Medicare claims data, the researchers calculated that average quarterly Medicare spending on program participants was between 7.7% and 13.3% lower than that of nonparticipants. Factoring in the cost of the program, this cost savings shrinks to between 4.3% and 9.8%.
Another study, which we covered here at Diabetes Flashpoints a couple of years ago, gave people with diabetes who lived in a rural area laptops. They used these computers to teleconference with their health-care team, to follow a Web-based diabetes education program, and to organize and share their blood glucose and blood pressure readings. While this program was found to improve medical outcomes slightly, it also cost 71% to 116% more than standard care. The study authors pointed out, however, that other telemedicine programs have been far less expensive, and that in the real world people might be able to use their own computers, which would help save money.
The Centers for Medicare and Medicaid Services has certainly not given up on the idea of telemedicine. Earlier this month, according to an article at HealthDataManagement, it announced a new pilot program that will give members of “an underserved minority community” in Dallas smartphones to help manage their diabetes. AT&T has agreed to fund the study and provide the smartphones, which participants will use to videoconference with diabetes educators. If this program is found to improve medical outcomes, the next question, of course, is how its benefits might be applied more broadly: Who will pay for smartphones, and for the time health professionals devote to communicating with patients using new media?
What do you think of telemedicine — does it hold promise for diabetes care? Would you be interested in videoconferencing with your health-care team on a computer or smartphone? Would you pay for a phone or for software in order to do so? Do you think you would like — for example — to receive a call from your health-care team whenever you forget to check your blood glucose or enter it on software on your phone, or would this annoy you? Leave a comment below!